Table 4.

Feedback loops in the workforce and evidence-based practices model

Name of feedback loop	Feedback loop structure	Explanation of feedback loop	Participant quotations
R11: Dissemination of evidence-based practices mitigate structural stigma		Awareness of evidence-based practices for perinatal SUD can grow through accessible training and dissemination efforts, which drives down structural stigma through increased institutional and organizational knowledge of SUD as a treatable medical condition. Lowering levels of structural stigma encourages the spread of evidence-based practices as systems are more likely to share and promote their knowledge and best practices.	“At the end of the day, [the child welfare and criminal justice system] want the babies to be safe too…. But it’s how they’re trying to accomplish that that isn’t necessarily congruent with our evidence.”—Hospital Nursing Director of Women’s Health
R12: Dissemination of evidence-based practices mitigate social stigma		Similarly to R11, a high level of awareness and accessibility of evidence-based practices works to change beliefs around perinatal SUD and reduces individual social stigma. As social stigma decreases, awareness and access to evidence-based practices increase.	“When healthcare professionals have access to human stories, evidence-based policies and procedures, we start to see behaviors and attitudes change. We start to see healthcare professionals recognizing people with perinatal addiction as human. They start treating people with kindness again.”—Nurse-Midwife
R13: Structural and social stigma can limit the influence of evidence-based practices		High levels of structural and social stigma can reduce the implementation of evidence-based practices. When providers and systems operationalize a false belief that SUDs represent an individual moral failing it thwarts the spread of evidence-based practices for perinatal SUD by reducing stigma-free training and knowledge sharing opportunities.	“Our healthcare and criminal justice systems continue to operate under the idea that pregnant people should be able to stop using drugs when they get pregnant—even though an inability to stop using is a defining part of the disease of substance use disorders. Until we stop blaming people for their medical conditions at a system level, we will not allow pregnant people to consistently disclose their disease and access treatment.”—OBGYN Provider